Abstract
15609 Hepatic arterial 90Yttrium microspheres has been associated with prolonged survival and low toxicity in the treatment of hepatocellular carcinoma (HCC). Till recently, a common therapy has been hepatic artery chemo-embolization (TACE). A randomized controlled trial (RCT) was therefore started, comparing cisplatin-TACE with 90Yttrium microspheres (TheraSphere, MDS Nordion) for patients with unresectable HCC. Plan: to give either a single dose of 90Yttrium to the liver lobe with the most tumor and re-treat only for tumor progression, or, to treat with repetitive cisplatin-TACE every 2 months. End-points were: tumor responses by CT, toxicities and over-all survival. Inclusion criteria: unresectable, baseline untransplantable, biopsy-proven HCC; bilirubin < 1.8mg/dL, granulocytes >1500 and platelets >70 K. Exclusion criteria: metastases,> minimal ascites, ECOG PS>2. Currently, 9 patients (pts) are evaluable for response to TACE arm and 10 to 90Yttrium. CT responses. TACE: CR=0, PR=2, SD=3, PD=3, lost to f/u=1. CT responses. 90Yttrium: CR=0, PR=2, SD=7, PD=0, lost to f/u=1. 7 pts subsequently had liver transplants (90Yttrium-4, TACE-3). Number of treatments. TACE: 1 cycle, 1 patient; 2 cycles, 3 pts; 3 cycles, 4 pts. 90Yttrium:1 treatment, 9 pts; 2 treatments, 1 pt. Survival in non-transplanted: 90Yttrium: 34,32,24,5,4 mo; TACE 26,22,4 mo. Toxicities: >50 % decrease in WBC: 2 pts on TACE and 1 pt on 90Yttrium. >50 % decrease in platelets: 2 pts on each treatment. Bilirubin >200% increase was found in 2 pts on TACE and 3 pts on 90Yttrium. PVT: 2 worsened on TACE, none on 90Yttrium. Worsened ascites: 1 pt on TACE, 2 on 90Yttrium. New lobar liver atrophy: 1 pt on TACE, but 4 pts on 90Yttrium. Conclusions: 90Yttrium microspheres treatment appears to be a credible alternative to TACE for management of HCC patients. Pts have fewer hospitalizations and treatments and survival so far seems equivalent. It is relatively safe and minimally toxic, but pts can have bilirubin elevation and long term lobar atrophy. No significant financial relationships to disclose.
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